HIV Department, World Health Organization, Avenue Appia, 1211 Geneva, Switzerland.
Global Health. 2008 Sep 16;4:8. doi: 10.1186/1744-8603-4-8.
There is increasing debate about whether the scaled-up investment in HIV/AIDS programs is strengthening or weakening the fragile health systems of many developing countries. This article examines and assesses the evidence and proposes ways forward.
Considerably increased resources have been brought into countries for HIV/AIDS programs by major Global Health Initiatives. Among the positive impacts are the increased awareness of and priority given to public health by governments. In addition, services to people living with HIV/AIDS have rapidly expanded. In many countries infrastructure and laboratories have been strengthened, and in some, primary health care services have been improved. The effect of AIDS on the health work force has been lessened by the provision of antiretroviral treatment to HIV-infected health care workers, by training, and, to an extent, by task-shifting. However, there are reports of concerns, too - among them, a temporal association between increasing AIDS funding and stagnant reproductive health funding, and accusations that scarce personnel are siphoned off from other health care services by offers of better-paying jobs in HIV/AIDS programs. Unfortunately, there is limited hard evidence of these health system impacts. Because service delivery for AIDS has not yet reached a level that could conceivably be considered "as close to Universal Access as possible," countries and development partners must maintain the momentum of investment in HIV/AIDS programs. At the same time, it should be recognized that global action for health is even more underfunded than is the response to the HIV epidemic. The real issue is therefore not whether to fund AIDS or health systems, but how to increase funding for both.
The evidence is mixed - mostly positive but some negative - as to the impact on health systems of the scaled-up responses to HIV/AIDS driven primarily by global health partnerships. Current scaled-up responses to HIV/AIDS must be maintained and strengthened. Instead of endless debate about the comparative advantages of vertical and horizontal approaches, partners should focus on the best ways for investments in response to HIV to also broadly strengthen the primary health care systems.
针对艾滋病毒/艾滋病规划的投资规模不断扩大，这是否在加强还是削弱许多发展中国家脆弱的卫生系统，这方面的争论日益增多。本文审查和评估了相关证据，并提出了前进的方向。
主要全球卫生倡议为艾滋病毒/艾滋病规划带来了大量资源。政府对公共卫生的认识和重视有所提高，这是积极影响之一。此外，向艾滋病毒感染者提供的服务迅速扩大。在许多国家，基础设施和实验室得到了加强，在一些国家，初级卫生保健服务得到了改善。通过向感染艾滋病毒的卫生保健工作者提供抗逆转录病毒治疗、培训以及在一定程度上通过工作移交，艾滋病毒对卫生工作者队伍的影响有所减轻。然而，也有一些关切的报道，其中包括艾滋病毒/艾滋病资金增加与生殖健康资金停滞不前之间存在暂时关联的报告，以及指责艾滋病毒/艾滋病规划提供薪酬更高的工作机会，从而从其他卫生保健服务中抽调稀缺人员的指控。不幸的是，关于这些卫生系统影响的证据有限。由于艾滋病服务的提供尚未达到可以被认为是“尽可能接近普及服务”的水平，因此，国家和发展伙伴必须保持对艾滋病毒/艾滋病规划投资的势头。与此同时，应该认识到，全球卫生行动的资金甚至比应对艾滋病毒流行的资金还不足。因此，真正的问题不是是资助艾滋病还是卫生系统，而是如何增加两者的资金。
主要由全球卫生伙伴关系推动的针对艾滋病毒/艾滋病的扩大应对措施对卫生系统的影响好坏参半，证据混合不一，但总体上是积极的。目前对艾滋病毒/艾滋病的扩大应对措施必须维持和加强。合作伙伴不应无休止地争论垂直和水平方法的相对优势，而应专注于投资应对艾滋病毒的最佳途径，以便广泛加强初级卫生保健系统。
